What inspired you to become involved in global health and development?

In 2007 I was doing graduate work at Columbia University, studying international affairs and public health,and I interned at Partners in Health during that summer. I never really saw myself working in the medical field because I had no plans to go to medical school, but while I was interning I saw how broad PIH’s approach to health care and poverty alleviation was, and I wanted to stay involved.

I had been working in Haiti a few times before the earthquake in January 2010, and after the earthquake I just began helping to fill gaps and meet the huge demand on PIH to expand their nutrition work. I had been to Haiti for a practicum while doing my Masters, so I spoke some Creole and was familiar enough with the country to help out during the chaotic aftermath. So to make a long story short, I had the same experience as countless others do of seeing a problem in the world and wanting to do something about it, and PIH is the venue through which I could do that.

Does PIH solely provide medical care, or does it work more broadly, to set up local health care infrastructure in the countries in which it works?

PIH is known as a health care organization, but we don’t believe in setting up our own parallel programs in countries; rather, we work only on the invitation of governments, and we only collaborate with existing systems or authorities. This is because if you set up a rival health care system or a network of independent health clinics in a country, it will only detract from that country’s long-term development of a functional medical system. If we need to leave that country one day because of a lack of funding or for any other reason, the country would be left with no more tools than it had to begin with. We work to give local and national authorities the tools they need to develop their own systems. This sometimes means we’re working in the worst facilities in the country, which presents its challenges, but that’s the whole reason why we’re in those countries—to bring the lowest-level health care up to better conditions.

The most distinctive aspect of PIH’s approach to health development is that we treat not just an infection, but the determinants of the infection, like a person’s job, diet, their access to clean water, etc. You can’t treat someone with tuberculosis in a clinic and then send them home to a dirt-floored, unsanitary home, because they’ll just get sick again and come back to the clinic. We know that the root cause of disease is poverty, and we can’t treat one without working with the other.

Integral to our poverty-alleviation work is employing people in the countries in which we work. PIH and our affiliates have about 15,000 employees worldwide, but only 200 of these work in our Boston, MA headquarters. The rest are working in the field, mostly as community health workers, who receive training and tools to travel around their communities, visit people in their homes, and give them medicine if they are unable to come to our facilities. People who are subsistence farmers or are working two jobs do not have time to travel to our clinics, and PIH health workers who know their neighbors and communities, as well as cultural norms or taboos of which we may not be aware, can reach those people and also deliver the important social aspect of medical treatment.

Have you noticed any changes in access to medication or the rate of treatment and cure of diseases since you started working in public health?

It is easy to see how things have changed just from the early 2000s to today. The expansion of access to HIV/AIDS medicine has revolutionized how effective its treatment is; medication used to be US$100,000 per patient, and now it is about US$1,000 per patient, which is still high, but allows us to reach so many more people.

We have also seen countries overcome the vehement resistance on the part of governments to treat people who were basically condemned to die anyway, and who were usually the poorest members of society, giving little incentive to spend money on treatment. People used to be shunned for seeking free medication and health care. We have witnessed a shift away from those ideas, and in places where 100 people were on antiretroviral (ARV) medication in the 2000s, there are now thousands on these ARVs. There are 7 million people worldwide now on HIV medication.

So it has been an amazing decade to be involved in public health and to witness the scaling-up of how many people we are able to treat, where we can reach them, and how broadly we can address their health needs—rather than handing out medication or vaccinations, as though we were part of an assembly line. Now when we go into a country we are not just building a clinic, we are building a system.

How is the situation in Haiti now? Are people in Haiti still in need of funding and support?

There has been a lot of great positive change since the earthquake. So much has been done, but so much still needs to happen, and the danger right now is that interest and awareness of the situation in Haiti is subsiding, and the situation is perceived as less dire and less in need of funding.

Right after the earthquake there was a huge influx of services and donations—latrines and other facilities were set up that helped alleviate the immediate crisis. But as the emergency subsided, this support has faded. Around 500,000 people are still living in makeshift tents in Haiti, and with the rainy season approaching, we will almost definitely see another spike in cholera infections.

What needs to happen now is we need to get the money that’s been pledged by countries and private donors into the hands of the Haitian government and officials, to give them autonomy and tools to rebuild their services. The country is not going to be rebuilt by NGOs, no matter how many are working in Haiti—the money and responsibility need to be in the hands of the government if there is any hope of building a permanent, functional state and infrastructure.

I know that President [Michel] Martelly is very engaged in fighting child hunger and developing agriculture, so there is definite hope and promise on the horizon for Haiti. The country lost 25 percent of its civil service in just a few seconds—it lost all of its forward momentum in national development—and it needs trust and support to regain that momentum for itself.

Jim Yong Kim, one of the founders of PIH, was recently nominated to head the World Bank. What do you think his background in public health will bring to World Bank policy and programs?

Having someone who is not an economist head the World Bank will definitely be a game-changer, and Jim’s approach to problem-solving is unique. His sole mission has always been to find innovative ways to combat poverty, and this mission is borne out in PIH. Jim doesn’t think just from a single organization’s perspective; he is trying to change the whole system of global public health, and he has really innovated the field of public health delivery. As huge populations are living in transition countries, meaning they are no longer overwhelmed by poverty but still lack important services and infrastructure, now is an important time to focus on bringing that 1 billion at the bottom of the world’s population, who still experience chronic hunger and poverty, up to a decent standard of living. Jim is the best person I could think of to take on that task.